Provider Demographics
NPI:1891721452
Name:BOX, MARLA GAY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:GAY
Last Name:BOX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 COX LN
Mailing Address - Street 2:
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834-4665
Mailing Address - Country:US
Mailing Address - Phone:830-876-9066
Mailing Address - Fax:
Practice Address - Street 1:1022 GARNER FIELD RD
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4867
Practice Address - Country:US
Practice Address - Phone:830-279-4544
Practice Address - Fax:830-876-9076
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11472101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060827OtherVALUE OPTIONS PROVIDER NO
TX266591OtherCOMPSYCH PROVIDER NO.
TX2690LCOtherPROVIDER NO.